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Code Blue! California’s medical cannabis ID card system has collapsed

November 11, 2019
california medical marijuana cards
Patients must buy almost $3,000 of cannabis per year to break even on the cost of an ID card, a Leafly analysis finds. (FilippoBacci/iStock)

Virtually none of the estimated hundreds of thousands of California patients entitled to purchase tax-free cannabis are getting those savings—because the state’s medical marijuana ID card system has collapsed, new data from the California Department of Public Health shows.

Patients say it's just too burdensome and costly to get one.

In a state of 40 million people, just 4,551 patients had the official medical marijuana ID card, according to CDPH totals for the fiscal year 2018-2019, which ended June 30.

Adult-use legalization—with its 600 stores and delivery services, plus the legal right to grow at home—has made the card partially obsolete for adults 21 and over. Those seeking the official ID card say that it’s costly and time-consuming to obtain and often not worth the hassle. One of the country’s oldest medical cannabis card programs might need to be retooled or scrapped.

california medical marijuana cards

Active state ID card totals are down 65% from their 2010 peak. (Leafly, California Department of Public Health)

“Is the program serving the people it should? No,” said Debby Goldsberry, operator of the Magnolia Wellness dispensary in Oakland, and an ID cardholder. “The cost is too high. People don’t buy that volume of cannabis, and there’s no value to them.”

“It’s messed up,” said Michele Aldrich, a longtime San Francisco medical cannabis activist and ID cardholder.

System antiquated, distrusted

California’s medical marijuana ID card system is America’s oldest, one of its least restrictive, and arguably one of its least functional.

The world’s first medical marijuana law, California’s Proposition 215, passed in 1996. But it didn’t actually legalize medical marijuana. It offered an awkward medical defense in court for those with a doctor’s note.

Patients say, ‘Why should I have to register with the county like some sex offender?’

By 2004, cops had grown tired of trying to verify more and more doctor’s recommendations during police stops. So the California Legislature passed Senate Bill 420, which created an ID card system and gave cops a state number to call to verify patients. Cardholders couldn’t be stopped solely for possessing a permissible amount of cannabis.

“It does offer a little more protection” than Prop. 215 offered on its own, said Ellen Komp, co-director of California NORML.

But the card system never really caught on. Patients didn’t have to get the card—it’s voluntary for those who want extra legitimacy. By contrast, later medical cannabis states mandated ID cards. “Because it was voluntary,” Komp said, “it was set up for failure.”

Also, there’s the privacy issue. Telling the state that you use a federally illegal Schedule 1 controlled substance turns off a lot of people, said Komp. “Patients say, ‘Why should I have to register with the county like some sex offender?’”

The Prop 64 tax break failure

California’s medical ID program peaked at 12,659 cards in circulation in the fiscal year ending 2010.

The state’s 2016 adult-use measure, Proposition 64, granted state medical ID cardholders an exemption from state and local sales taxes, which run 7.25% to 10.25%. Other medicines aren’t taxed, either.

Medical ID cardholders can also obtain their medicine in other states that have so-called “reciprocity” rights.

Holding a card can ease interactions with law enforcement. Medical marijuana patients can possess more than the state’s adult-use limit of one ounce in public, and six plants on your property.

“It’s a brighter white line,” said Komp.

California did $1.91 billion in cannabis sales in its first adult-use year, 2018, yet almost no one took the medical sales tax break. Why?

Because getting a medical marijuana ID card in California sucks. “It’s absurd,” said Aldrich.

Getting a card is a part-time job

Here’s what a patient will tell you: First you have to find a doctor who will write you a note, and there are fewer of them now under adult-use legalization. Make an appointment. Go to the doctor’s office and pay about $150 for the consultation, maybe more.

Then find out how to make an appointment with your county health department, and schedule that weeks in advance, schlep to some county health office, bring the right paperwork, and pay up to $100. The county has 30 days to verify the application, then 30 days for the state to make the card, then you might have to come back to the county health office to pick up the card.

Yay! Now you can save an average of 8.37% sales taxes on your cannabis purchases. So go out there and purchase at least $2,986 worth of cannabis products, at which point you’ve saved enough in sales taxes to have paid for the doctor’s visit and card ($250).

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“It costs an enormous amount of money to get a card,” said Goldsberry.

Oh, also: After one year, the card expires and you have to repeat the entire process.

No teleconferencing allowed

Each of California’s 58 counties administers the state ID card system on a local level. So in Goldsberry’s Alameda County, waits are three weeks just to get a card appointment. Alameda County issued 467 cards last fiscal year, maybe two per business day.

In San Francisco, the birthplace of cannabis compassion, waits are two weeks to get a county health appointment. You have to show up in person, even if it requires an ambulance to bring you, Aldrich said.

Aldrich learned that the hard way earlier this year when her husband, Michael, went to renew the card of a bed-ridden woman for whom he has been a caregiver for the past six years. The woman, in her 60s, has intractable and debilitating chronic pain from hip and knee injuries. San Francisco County Health wants her down at the health office to renew her ID card, said Aldrich. Unlike last year, a picture of the patient, or a consult via teleconference, won’t do.

An aimless government program

What is the total addressable market of people in California who qualify for medical cannabis?

It could be 915,845 patients, if California’s system worked as well as Arizona’s, or 1.2 million if it worked as well as Maine’s ID card system.

Instead, no one knows. The California Department of Public Health told Leafly it has no quotas for program success. Neither do the counties.

“There is no target goal for issuing a number of [cards],” a staff member at the Los Angeles County Department of Public Health told Leafly in an emailed statement. LA County has issued 138 medical marijuana ID cards so far this fiscal year, for a population of 10.1 million people.

'There is no target goal for issuing a number of cards.'
Los Angeles County Dept. of Public Health Communications Department

“It is likely that the numbers of MMICs issued have decreased as other options are now available for legal purchase,” the LAPDH staff member wrote.

LA County, which encompasses 4,751 square miles, has seven Public Health offices where patients can set up appointments. The county does not keep data on wait times for an appointment, but “the program is not aware of long waits for the applicants to get an appointment with our department.”

Patients turning to a toxic, illicit market

LA County, Tulare County, and Kings County each have recorded one death and dozens of illnesses caused by vaping illicit market THC vaporizer cartridges. Victims report shopping in the black market because they cannot afford the high cost of tested products.

Tulare County Public Health Division Manager Cecilia Herrera told Leafly the county’s medical ID card system is a success because it follows applicable state laws. Getting a card can take up to six weeks and $100 in fees, plus the doctor’s visit cost. Tulare has issued a total of four ID cards this fiscal year.

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“The decrease in numbers of MMJ ID Cardholders is likely due to recent changes in legalization. … The Tulare County decrease is consistent with the state trend,” Herrera said.

Kings County Assistant Director of Public Health Nancy Gerking also considers her county’s program a success. Getting a card there can take as little as about two weeks, and two visits to the county health office. The rural county has four active medical marijuana cards, for 151,000 people. “We are proud to say we believe our program at Kings County to be successful,” Gerking said. “That’s largely due to the fact our turnaround time is very short.”

Kings County is down from a 2015 peak of eight cards. Gerking couldn’t say why, though she had a theory: “Since the legalization of recreational marijuana the cards may have become less desirable.”

Should we shut it down?

Given how few people get ID cards and how much it probably costs taxpayers, should we just shut the program down and give the sales tax break to anyone with a doctor’s note? It’s tough to say.

“I wouldn’t have a problem with that,” said NORML’s Ellen Komp.

“It doesn’t have that much utility,” said LA. lawyer Alison Margolin. “And I support medical marijuana.”

The biggest loss would be to medical cannabis travelers. “I need my reciprocity,” said Oakland patient Debby Goldsberry.

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Instead, Goldsberry recommended lowering county application fees to $20 or $30, plus a statewide educational campaign about the advantages of the ID card.

Many former medical patients shop in adult-use stores. That adds up to a likely overpayment in the tens of millions of tax dollars statewide. “I’m still seeing patients” at Magnolia Wellness, said Goldsberry. “They just don’t get their card anymore. They don’t understand the value.”

Ultimately, medical cannabis preceded adult-use legalization, and that paradigm is too valuable to lose, she said.

“Cannabis can be used as a targeted medicine to help a wide variety of conditions,” Goldsberry said, “and we’ve just started looking at the tip of the iceberg in terms of what the plant can do and how it can help people. This is not the time to take the market away from helping people have these transformative experiences. We need to bring the focus back to cannabis as a plant that helps people.”

  • Dicey

    Never knew anyone that got the actual card. Everyone just got a Doctor’s Rec instead, which dispensaries expected and accepted. They always asked to see your Rec, never your ‘card’.
    I know of one dispensary that gives a discount for medical if you have a rec. Never seen discounts at any others, and definitely no tax-free sales.
    Strongly suspect that if someone shows up with a card at a legal shop, people working there wouldn’t even know what it is, let alone what to do with it.
    CA medical program is super dead.

  • If cities and counties would give out the state medical cannabis card for FREE as prop 64 allows, the recreational taxes reimburse city and counties for all expenses. There are a tremendous amount of indigent people that qualify and deserve this card that cities and counties are refusing to let them have as state law allows. There are many others that get the card for half price for being on Medicaid there by not having to spend $3000 to get the benefits. The card makes it easy for people to sign up and join cannabis clubs. The card is respected by law enforcement. The card allows you to purchase and carry more cannabis and cannabis products. I certainly believe the card program still has a reason to exist, although the City of San Francisco needs to give the card to indigent people for FREE sooner rather than later!

    • Gil Latimer

      that some medically indigent are refused cards is disturbing. .according to 64, “Upon satisfactory proof that a qualified patient,… is a medically indigent adult who is eligible for and participates in the County Medical Services Program, the fee established pursuant to this section shall be waived.” Unfortunately, “shall” means “may” – cold-blooded afaic.

  • okpkpkp

    Been a medical patient in California since 2004. Just got my card last year. I spend $200-240 a month on weed products. I am disabled and it is difficult for me to grow weed. Besides, I don’t smoke anymore. I vape, use tinctures, use topicals on my skin to reduce my pain. I cannot make any of these and frankly don’t want to. I agree that the ID Card here in California needs work and needs a major price cut. Who will do it? My card took 3-4 weeks and I only got it for 51 weeks instead of a year. Why they delayed a week getting it to me I’ll never know.

  • Jake Jones

    Very miss informed when using Arizona as an example. Oregon is a much better example. Arizona doesn’t have legalization to show a difference. Also Arizona medical marijuana is taxed, not very good product either, better than Nevada though but just barely since Arizona just started testing cannabis, but Arizona has just as expensive cannabis as California. So where exactly is this person getting there info? Arizona medical marijuana is highly abused since their mm doctors don’t require proof of any illnesses. Which defeats the legitimatacy of their program.
    ALL marijuana is expensive in all medical/ legalized states due to greedy coporations like MedMen that think capitalism is great. Wonderful way to exploit sick people. No different than any pharmaceutical company.

    • Stimpy

      I have and use the AZ MM card. I have a legit qualifying condition and not some vague aches and pains BS which must apply to most of the youngsters I see in the MM doctor’s office applying for a card. My qualifying condition is cancer and to renew my card I need to show evidence that I’ve seen a doctor for this condition recently. The expense of a card is a hassle — $100 for the MM doctor and $150 fee to the state. They’ve recently extended the validity period of the card from 1 year to 2 years. I doubt that I spend more than $500 a year on cannabis but I value the privilege of being able to do so. I voted for MM legalization as well as general use legalization, which didn’t pass. I don’t have a basis for comparison but I think the cannabis product here is just fine and I feel like a kid in a candy store visiting my local dispensary, and there are plenty to choose from.

    • Stimpy

      I had to show proof of being treated for my qualifying condition — cancer — to get my AZ card and renew that card. Had to show that I had seen a doctor recently for this condition, which seemed odd.

    • Dianne

      It’s not expensive in all legal states. The CO dispensary I was going to as a medical patient I could buy $5 grams, $20 eights, $75-$80 ounces, when they had specials, which was often. On various holidays the specials were even better.

  • Bruce Goren

    Yup, waste of money and time. Let mine lapse when Prop 64 passed.

  • Chip Johnson

    I have to agree. It does not stop taxes, just cuts a few, a bit. Legit weed has just gotten EXPENSIVE in CA! I got my card for out of state travel. As more states allow you to apply for temp out of state cards, as I understand Hawaii is planning, the card is more useful. And BTW 2,986$ a year is about my cannibals expense amount.

  • informativex

    $250 to have a card says you are entitled to a specific medicine? Funny how opioid pharmceutical companies don’t have any such restrictions on their medications. Just cannabis suffers from these philistine government abuses. Funny how that works.

    • Mr. Lucas Brice

      It’s a lie. You can get a rec from a doctor for $39.

    • mysticwine

      Reefer Madness

    • Brady Harness

      Thus is why in 1989 I pulled up stakes and moved away from Ca. and built another company in Arkansans; as a history Buff I saw even back then the roots of Insanity (Socialism) sprouting !!!

  • StellaRay

    I live in California for 33 years. Ever since they demanded Medical cards for legal use of Cannabis, I got one. I literally walk around the corner to see a REAL DOCTOR, It cost me 40 bucks for the Doctor visit and an extra 30 or something for the Picture ID which was optional. I have never had to go “Downtown to a County office” nor paid the outlandish price you mention. Nor wait the two to 4 weeks you mention…Its done in 20 minutes…I show the card and get a minimal tax break. I’ve been a cannabis user for near 52 years…I wish it was NEVER LEGAL for Recreation. I voted against it. As I knew for sure that government and big business would get their hands on it, mix it with thinners IE Vitamin E acetate and put their greedy their fingers in the pie, and ruin The very medicine that God made. NOW, they halved the dose You have to eat a whole candy bar to feel anything and doubled the price and if you read the ingredients of a lot of edibles you wouldn’t eat this ever…as it is mixed with corn oils and other cheap stuff. Everything is in a package or has a warning on it (isn’t cannabis good for Cancer and a good anti- inflammatory ?.
    …gone are the days when you could walk in to a POT SHOP and explore the goods with out seeing a cancer label prop64..or some other BS. And, you could get samples, or a free joint here and there some places even had happy hours where you could go in the back and do dabs or whatever they were showing that day. It was all FRESH…I’ve been using those little vape pens for years now…They helped enormously at first. And I loved the discretion of it all…Now I’m scared to use them. I keep wondering what ‘Opposite’ company or medicine, is trying to get Vape off the market? I wish I did have an illegal dealer like the old days, and just get a baggie of DANK smelling skunk, good seasonal weed. Not some stuff that is dried out and probably sitting in a WAREHOUSE somewhere in the dessert…Where they try to come up with ridiculous names!

    • Matt

      StellaRay. This sentiment is exactly how the vast majority of cannabis users feel about the market in California. There is a drastic difference between the landscape in 2010 compared to now. Absolutely correct about every point you made.

      • Mike Yaeger

        I dont think legalization has worked out as intended. My brother and I talk all the time about how much better the pot was before legalization. And pot is the only product i know of where the wholesale price has been cut by about 75% while the retail price has skyrocketed. I cant buy pot as good as what we used to regularly get in CA, OR, and CO in any pot shop in any of those states(i do like that I can legally grow) Once authorities come up with a breathalyzer for pot, which they are working on and I don’t think they would be except for legalization, there are going to be a lot more people wishing it had never been legalized!

    • dretondo

      Well said Stella. I too remember the days of skunk and red bud,and gold bud. All so flavorful and dank. Dont mind the seeds. I think all this so called fancy med grade mj. is tasteless and weak.The buds all look beautiful, but the quality does not match the look. I had to start doing dabs at age 65 to really get high anymore!

    • StellaRay – High! – this article is talking about the State of CA ID card that would entitle someone to go to other medical cannabis states with a reciprocity agreement and buy medicine locally – they only accept State issued cards.

    • Missy250

      I’m a medical cannabis user in Michigan and I had to grow my own to be able to afford it. It has been worth it to me and I know I don’t use any fertilizers or pesticides so that helps relieve my mind a little.

      • Stimpy

        That would be fun. I can’t cultivate, only buy from a medical M dispensary here.

  • FlunkedAgain

    One of the country’s oldest medical cannabis card programs might need to be retooled or scrapped.

    You don’t need an ID card to buy Aspirin, or Metamucil.
    Adult Use MJ = Over the Counter Medical MJ.

    Not every Medical MJ patient needs to be monitored.

  • Old Man

    “I do what I want” …Cartman

  • Mr. Lucas Brice

    So much misinformation here. I just renewed my MMJ card, with a doctor, over the phone. It took 10 minutes and cost a whole $39. It entitles me to use dispensaries that deliver.

  • mysticwine

    Is not the medical potency far greater then the rec potency?

    • Stimpy

      Nope. I can only get medical but the info on the dispensary sites show widely varying potency including some heavy hitters.

  • Prop 64 is a death nail to medical cannabis. It’s correct to say that most of the taxes in California law are forced to be included into the price of the product. The only tax a patient can escape with a state cannabis card is local sales tax. Most cannabis doctors were forced or put out of business. There are a lot of benefits to having this state cannabis card still although the writing is on the wall For the program if cities like San Francisco will not even give indigent people their cards for free as required by law. San Francisc’ Health Departments excuse is that they already have “Healthy San Francisco“ so they are not required to participate in this program. So sad!

  • Rsteeb

    I haven’t had to pay a doctor for a note, as my Kaiser ophthalmologists have all observed the effect on my glaucoma, and so stated in their rec’s. I have a collection of OCBC cards dating back to 2001. I began subscribing to the State ID card/protection racket after it became a requirement to avoid sales tax. Unfortunately, the state finds taxing medicine NOT to be unconscionable, so I expect to renew again next month. What a PITA.

  • 1Reasonable1

    Having a medical cannabis program is important. After medical states become recreational, dispensaries become “liquor stores” rather than pharmacies. With the change in client base, there is little incentive to invest in the training and education required for patients to obtain the best possible results from medical cannabis. The knowledge and experience in using cannabis for medical purposes fades away…. The vast majority patients who use any cannabis they pick up off the street will see an improvement in their symptoms. Many patients are happy for any improvement and stop at this point, particularly in prohibition and recreational states. Achieving an excellent response is usually quite a bit more complicated.

  • Dianne

    They should have a system like CO. I went to my doc & paid my normal $20 co-pay. He submits all my required info into the State of CO MMJ online system while I’m there. I go home, log into the state’s online portal, pay my card fee ($35 or so), print out my card & I’m done, all the same day. Easy peasy. AND, MMJ patients are only taxed 6 or 7%. I wish I wasn’t living in an illegal state now. 🙁